{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:29:13Z","timestamp":1790998153889,"version":"4.1.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>It is unclear how long youth with opioid use disorder (OUD) should continue taking buprenorphine, and what adherence they should achieve. We identified patterns of duration\/adherence and assessed associations with subsequent overdose, emergency department (ED) use, and hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective cohort analysis used 2014\u20132022 data from the Massachusetts Public Health Data Warehouse. We identified youth aged 13 to 26\u00a0years initiating buprenorphine and used group-based trajectory modeling to categorize youth into duration\/adherence trajectories over 12\u00a0months. Using multivariable Cox regression, we examined associations between trajectories and time to fatal\/nonfatal opioid overdose, all-cause ED use, and all-cause hospitalization during the subsequent 12-month period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 11\u2009649 Massachusetts youth initiating buprenorphine, most were aged 21\u00a0years or older (89.0%), male (60.3%), white non-Hispanic (85.9%), and enrolled in Medicaid (55.4%). We identified 4 patterns of medication use: (1) high adherence for 12\u00a0months (23.7%); (2) low adherence for 12\u00a0months (27.5%); (3) discontinuation in 3 to 9\u00a0months (16.4%); and (4) discontinuation in less than 3\u00a0months (32.5%). Trajectories included 580 (5.0%) and 774 (6.6%) youth switching to methadone and naltrexone, respectively. Compared with high adherence for 12\u00a0months, overdose risk was higher with low adherence for 12\u00a0months (adjusted hazard ratio [aHR], 1.46; 95% CI, 1.24\u20131.73), discontinuation in 3 to 9\u00a0months (aHR, 1.82; 95% CI, 1.52\u20132.17), and discontinuation in less than 3\u00a0months (aHR, 1.76; 95% CI 1.50\u20132.06). Compared with high adherence, low adherence and discontinuation in less than 3\u00a0months had higher risk of ED use, and all other trajectories had higher risk of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Medication adherence may prevent overdose, ED use, and hospitalization. Strategies to increase treatment duration\/adherence likely avert harm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2025-071147","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:02:42Z","timestamp":1763424162000},"source":"Crossref","is-referenced-by-count":11,"title":["Buprenorphine Treatment Duration and Adherence Among Youth and Subsequent Health Outcomes"],"prefix":"10.1542","volume":"156","author":[{"given":"Scott E.","family":"Hadland","sequence":"first","affiliation":[{"name":"1Division of Adolescent and Young Adult Medicine, Mass General Brigham for Children, Boston, Massachusetts"},{"name":"2Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon D.","family":"Kimmel","sequence":"additional","affiliation":[{"name":"3Boston Medical Center, Boston, Massachusetts"},{"name":"4Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shapei","family":"Yan","sequence":"additional","affiliation":[{"name":"3Boston Medical Center, Boston, Massachusetts"},{"name":"4Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Bettano","sequence":"additional","affiliation":[{"name":"5Department of Public Health, Commonwealth of Massachusetts, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Hsuan","family":"Lo-Ciganic","sequence":"additional","affiliation":[{"name":"6Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"7Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"8Center for Clinical Artificial Intelligence, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"9North Florida\/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Bagley","sequence":"additional","affiliation":[{"name":"3Boston Medical Center, Boston, Massachusetts"},{"name":"4Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica B.","family":"Calihan","sequence":"additional","affiliation":[{"name":"3Boston Medical Center, Boston, Massachusetts"},{"name":"4Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather E.","family":"Hsu","sequence":"additional","affiliation":[{"name":"3Boston Medical Center, Boston, Massachusetts"},{"name":"4Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R.","family":"Larochelle","sequence":"additional","affiliation":[{"name":"3Boston Medical Center, Boston, Massachusetts"},{"name":"4Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"2025113018572172900_r1","volume-title":"Key Substance Use and Mental Health Indicators in the United States: Results From the 2023 National Survey on Drug Use and Health","author":"Substance Abuse and Mental Health Services Administration","year":"2024"},{"key":"2025113018572172900_r2","doi-asserted-by":"crossref","first-page":"j1550","DOI":"10.1136\/bmj.j1550","article-title":"Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies","volume":"357","author":"Sordo","year":"2017","journal-title":"BMJ."},{"issue":"9","key":"2025113018572172900_r3","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1001\/jamapsychiatry.2021.0976","article-title":"Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence: a systematic review and meta-analysis","volume":"78","author":"Santo","year":"2021","journal-title":"JAMA Psychiatry."},{"issue":"2","key":"2025113018572172900_r4","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1056\/NEJMp2312084","article-title":"The overdose crisis among U.S. adolescents","volume":"390","author":"Friedman","year":"2024","journal-title":"N Engl J Med."},{"issue":"3","key":"2025113018572172900_r5","doi-asserted-by":"crossref","first-page":"e20161893","DOI":"10.1542\/peds.2016-1893","article-title":"Medication-assisted treatment of adolescents with opioid use disorders","volume":"138","author":"Ryan","year":"2016","journal-title":"Pediatrics."},{"issue":"3","key":"2025113018572172900_r6","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.jadohealth.2020.12.129","article-title":"Medication for adolescents and young adults with opioid use disorder","volume":"68","author":"Society for Adolescent Health and Medicine","year":"2021","journal-title":"J Adolesc Health."},{"key":"2025113018572172900_r7","article-title":"Opioid use disorder treatment for youth","author":"American Academy of Child and Adolescent Psychiatry","year":"2020"},{"issue":"11","key":"2025113018572172900_r8","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1001\/jamapediatrics.2018.2143","article-title":"Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder","volume":"172","author":"Hadland","year":"2018","journal-title":"JAMA 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A national study of outpatient specialty treatment settings","volume":"126","author":"Krawczyk","year":"2021","journal-title":"J Subst Abuse Treat."},{"issue":"9","key":"2025113018572172900_r13","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1001\/jamapediatrics.2024.2502","article-title":"Pattern of buprenorphine treatment retention among youth aged 10 to 18\u00a0years-US, 2015 to 2021","volume":"178","author":"Connolly","year":"2024","journal-title":"JAMA Pediatr."},{"key":"2025113018572172900_r14","article-title":"Public Health Data Warehouse (PHD): overview","author":"Massachusetts Department of Public Health","year":"2018"},{"issue":"5","key":"2025113018572172900_r15","article-title":"Using data to guide action in response to the public health crisis of opioid overdoses","volume":"1","author":"Bharel","year":"2020","journal-title":"NEJM Catal Innov Care Deliv."},{"key":"2025113018572172900_r16","article-title":"Public Health Data Warehouse (PHD) technical 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